A Mobile Phone–Based Intervention to Improve Mental Health Among Homeless Young Adults: Pilot Feasibility Trial

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Abstract

Background

Youth homelessness is a substantial issue, and many youths experiencing homelessness have mental health issues as both a cause and consequence of homelessness. These youths face many barriers to receiving traditional mental health services, and as a result, only a few youths experiencing homelessness receive any form of mental health care.

Objective

This project aimed to develop and determine the feasibility and acceptability of engaging young adults (ie, individuals aged 18-24 years) experiencing homelessness in a remotely delivered mental health intervention. This intervention provided brief emotional support and coping skills, drawing from cognitive behavioral principles as an introduction into psychosocial support. The intervention was piloted in a homeless shelter network.

Methods

A total of 35 young adults experiencing homelessness participated in a single-arm feasibility pilot trial. Participants received a mobile phone, a service and data plan, and 1 month of support from a coach consisting of up to 3 brief phone sessions, text messaging, and mobile mental health apps. We evaluated feasibility by looking at completion of sessions as well as the overall program and acceptability with satisfaction ratings. We also collected clinical symptoms at baseline and the end of the 1-month support period. We used validity items to identify participants who might be responding inappropriately and thus only report satisfaction ratings and clinical outcomes from valid responses.

Results

Most participants (20/35, 57%) completed all 3 of their phone sessions, with an average of 2.09 sessions (SD 1.22) completed by each participant. Participants sent an average of 15.06 text messages (SD 12.62) and received an average of 19.34 messages (SD 12.70). We found higher rates of satisfaction among the participants with valid responses, with 100% (23/23) of such participants indicating that they would recommend participation to someone else and 52% (12/23) reporting that they were very or extremely satisfied with their participation. We found very little change from pre- to posttreatment on measures of depression ( d=0.27), post-traumatic stress disorder ( d=0.17), and emotion regulation ( d=0.10).

Conclusions

This study demonstrated that it was feasible to engage homeless young adults in mental health services in this technology-based intervention with high rates of satisfaction. We did not find changes in clinical outcomes; however, we had a small sample size and a brief intervention. Technology might be an important avenue to reach young adults experiencing homelessness, but additional work could explore proper interventions to deliver with such a platform.

Trial Registration

ClinicalTrials.gov NCT03620682; https://clinicaltrials.gov/ct2/show/NCT03620682

Related collections

Most cited references 24

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A meta-analysis of psychotherapy dropout.

Michael Wierzbicki, Gene Pekarik (1993)

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Is Open Access

IntelliCare: An Eclectic, Skills-Based App Suite for the Treatment of Depression and Anxiety

David Mohr, Kathryn Noth Tomasino, Emily G Lattie … (2017)

Background Digital mental health tools have tended to use psychoeducational strategies based on treatment orientations developed and validated outside of digital health. These features do not map well to the brief but frequent ways that people use mobile phones and mobile phone apps today. To address these challenges, we developed a suite of apps for depression and anxiety called IntelliCare, each developed with a focused goal and interactional style. IntelliCare apps prioritize interactive skills training over education and are designed for frequent but short interactions. Objective The overall objective of this study was to pilot a coach-assisted version of IntelliCare and evaluate its use and efficacy at reducing symptoms of depression and anxiety. Methods Participants, recruited through a health care system, Web-based and community advertising, and clinical research registries, were included in this single-arm trial if they had elevated symptoms of depression or anxiety. Participants had access to the 14 IntelliCare apps from Google Play and received 8 weeks of coaching on the use of IntelliCare. Coaching included an initial phone call plus 2 or more texts per week over the 8 weeks, with some participants receiving an additional brief phone call. Primary outcomes included the Patient Health Questionnaire-9 (PHQ-9) for depression and the Generalized Anxiety Disorder-7 (GAD-7) for anxiety. Participants were compensated up to US $90 for completing all assessments; compensation was not for app use or treatment engagement. Results Of the 99 participants who initiated treatment, 90.1% (90/99) completed 8 weeks. Participants showed substantial reductions in the PHQ-9 and GAD-7 (P<.001). Participants used the apps an average of 195.4 (SD 141) times over the 8 weeks. The average length of use was 1.1 (SD 2.1) minutes, and 95% of participants downloaded 5 or more of the IntelliCare apps. Conclusions This study supports the IntelliCare framework of providing a suite of skills-focused apps that can be used frequently and briefly to reduce symptoms of depression and anxiety. The IntelliCare system is elemental, allowing individual apps to be used or not used based on their effectiveness and utility, and it is eclectic, viewing treatment strategies as elements that can be applied as needed rather than adhering to a singular, overarching, theoretical model. Trial Registration Clinicaltrials.gov NCT02176226; http://clinicaltrials.gov/ct2/show/NCT02176226 (Archived by WebCite at http://www.webcitation/6mQZuBGk1)

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Little Treatments, Promising Effects? Meta-Analysis of Single-Session Interventions for Youth Psychiatric Problems.

Jessica L Schleider, John R Weisz (2017)

Despite progress in the development of evidence-based interventions for youth psychiatric problems, up to 75% of youths with mental health needs never receive services, and early dropout is common among those who do. If effective, then single-session interventions (SSIs) for youth psychiatric problems could increase the accessibility, scalability, completion rates, and cost-effectiveness of youth mental health services. This study assessed the effects of SSIs for youth psychiatric problems.

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Author and article information

Contributors

Stephen M Schueller:

Department of Psychological ScienceUniversity of California Irvine4201 Social & Behavioral Sciences GatewayUniversity of California, IrvineIrvine, CA, 92697United States1 9498243850s.schueller@uci.edu

ORCID: http://orcid.org/0000-0002-1003-0399

Journal

Journal ID (nlm-ta): JMIR Mhealth Uhealth

Journal ID (iso-abbrev): JMIR Mhealth Uhealth

Journal ID (publisher-id): JMU

Title: JMIR mHealth and uHealth

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Electronic): 2291-5222

Publication date Collection: July 2019

Publication date (Electronic): 02 July 2019

Volume: 7

Issue: 7

Electronic Location Identifier: e12347

Affiliations

[1 ] Department of Psychological Science University of California Irvine Irvine, CA United States

[2 ] Center for Behavioral Intervention Technologies Department of Preventive Medicine Northwestern University Chicago, IL United States

[3 ] Department of Psychiatry and Behavioral Sciences Rush University Medical Center Chicago, IL United States

[4 ] Stepwell Mental Health and Wellness Boulder, CO United States

[5 ] The Night Ministry Chicago, IL United States

Author notes

Corresponding Author: Stephen M Schueller s.schueller@ 123456uci.edu

Author information

Stephen M Schueller http://orcid.org/0000-0002-1003-0399

Angela C Glover http://orcid.org/0000-0002-4514-0379

Anne K Rufa http://orcid.org/0000-0003-0337-8263

Claire L Dowdle http://orcid.org/0000-0003-2731-3616

Gregory D Gross http://orcid.org/0000-0002-8383-4697

Niranjan S Karnik http://orcid.org/0000-0001-7650-3008

Alyson K Zalta http://orcid.org/0000-0002-5159-8431

Article

Publisher ID: v7i7e12347

DOI: 10.2196/12347

PMC ID: 6632101

PubMed ID: 31267980

SO-VID: e4204482-1642-4820-a5f9-b958c14b3987

Copyright © ©Stephen M Schueller, Angela C Glover, Anne K Rufa, Claire L Dowdle, Gregory D Gross, Niranjan S Karnik, Alyson K Zalta. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 02.07.2019.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/.as well as this copyright and license information must be included.

History

Date received : 27 September 2018

Date revision requested : 26 January 2019

Date revision received : 30 April 2019

Date accepted : 17 May 2019

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